Everything You Need to Know About Weight loss Medications

First, why is fat loss so difficult?

Fat loss is tough—plain and simple.

But for some people, it’s even harder due to a mix of environmental, genetic, physiological, social, cultural, and behavioral factors working against them.

Here are a few reasons why losing fat can be so challenging:

We live in a world that encourages overeating.

Think back 150 years, before cars and public transit existed. To get anywhere, you had to walk, bike, or ride a horse.

Food was also scarcer, and getting it required effort. Meals might satisfy hunger but didn’t often leave you feeling “full.”

Today, however…

“We live in an obesogenic environment filled with cheap, highly palatable, calorie-dense foods that make overeating easy, often without realizing it,” says Karl Nadolsky, MD, an endocrinologist and weight loss specialist at Holland Hospital and co-host of the Docs Who Lift podcast.

“On top of that, we have countless conveniences that reduce our need for physical activity.”

Yet, even in this environment, some people remain lean, while others struggle to keep the scale from creeping up. Why?

Genetics play a role in obesity.

Some genes lead to severe obesity from an early age, though these are rare.

More common is polygenic obesity—when multiple genes together predispose someone to weight gain, especially in an environment filled with calorie-dense food and less need for physical activity.

People with these obesity-related genes may experience stronger hunger cues and weaker fullness signals, explains Dr. Nadolsky.

These genes may also contribute to what’s often called “food noise,” where individuals feel consumed by thoughts like, “What am I going to eat next? When is my next meal? Can I eat now?”

Physiologically, the body tends to resist fat loss.

When you gain a significant amount of fat, the hormones in your gut, fat cells, and brain adjust, altering how you feel hunger and fullness.

“It’s like a thermostat that’s broken,” says Dr. Nadolsky. “So when people cut calories and lose weight, these physiological factors push back.”

After weight loss, your gut might keep sending out hunger signals, even if you’ve just eaten or have plenty of body fat stored for energy. It may also take more food for you to feel full compared to someone who hasn’t been at a higher weight.

Being in a larger body often subjects people to fat stigma and discrimination.

If you’ve never lived in a larger body, it can be hard to grasp how differently the world treats you.

Clients have shared experiences of being bullied at the gym, judged or lectured in public, and bombarded with assumptions about their body, health, and self-worth.

Even in medical settings, people with obesity are more likely to face inadequate care. Healthcare providers may dismiss symptoms, blaming them solely on weight, leading to missed or delayed diagnoses and subpar treatment.

All of this creates chronic stress, which can be isolating and emotionally harmful. This stress can also drive increased appetite, cravings for high-calorie foods, reduced physical activity, and poor sleep.

Which brings us to this point…

Taking medication isn’t the “easy way out.”

In 2013, the American Medical Association classified obesity as a disease.

Yet, many still view it as a willpower issue, attributing it to overeating and lack of exercise, with the simple advice to “just try harder.”

In truth, people with obesity have just as much willpower as anyone else. However, fat loss is harder for them due to genetic, physiological, and environmental factors.

Just as chemotherapy or insulin isn’t considered “the easy way out” for cancer or diabetes, medication isn’t an easy escape from obesity. Instead, it’s a tool, often used alongside healthy lifestyle choices, that helps address the genetic and physiological factors that individuals with obesity may have little control over otherwise.

Key Information About GLP-1 Drugs

In 2017, the synthetic GLP-1 agonist semaglutide was approved in the U.S. as a treatment for diabetes and obesity. This marked a breakthrough, offering people with obesity a safe, accessible way to achieve long-term weight loss, as long as they remain on the medication.

How GLP-1 Drugs Like Ozempic Work

Current weight-loss medications primarily function by mimicking glucagon-like peptide 1 (GLP-1), a hormone that helps:

• Regulate blood sugar by triggering insulin secretion in the pancreas, which also enhances satiety.
• Slow gastric emptying in the gut, extending the feeling of fullness after meals.
• Reduce cravings and food-related thoughts by affecting the brain’s reward system.

In people with obesity, the body breaks down natural GLP-1 too quickly, making it less effective. This can result in delayed satiety, less sustained fullness after meals, and frequent food cravings. Semaglutide and similar medications introduce synthetic GLP-1, which lasts much longer, helping to curb hunger, reduce between-meal cravings, and suppress obsessive food thoughts.

Interestingly, these drugs may also help reduce other addictive behaviors like compulsive drinking and gambling by calming the brain’s reward center, says Dr. Nadolsky.

Newer medications, such as tirzepatide, go beyond GLP-1 and also mimic another hormone, GIP (gastric inhibitory polypeptide), which further reduces appetite and enhances insulin secretion. Upcoming drugs like retatrutide are expected to target a third hormone, glucagon, further improving weight-loss outcomes.

Effectiveness of GLP-1 Medications

The effectiveness of weight-loss drugs is often measured by the percentage of people who reach key weight-loss milestones, such as losing 5, 10, 15, or 20 percent of their body weight.

While still evolving, these medications have shown promising results:

• 86 percent of those using GLP-1 drugs like Ozempic, Rybelsus, and Wegovy lose at least 5 percent of their body weight, and about one-third lose over 20 percent.
• Newer medications, such as tirzepatide, show even greater potential, with up to 57 percent of people losing more than 20 percent of their body weight.

Comparing GLP-1 Drugs to Lifestyle Interventions

Traditionally, weight loss has relied on lifestyle interventions like diet, exercise, and counseling. However, it’s more beneficial to view lifestyle changes and medications as complementary rather than competing approaches.

With lifestyle modifications alone, individuals typically lose about 5 to 13 percent of their body weight. When combined with FDA-approved weight-loss drugs like GLP-1 agonists, average weight loss increases by 10 percent or more, offering significantly better outcomes.

Fat Loss Often Brings Significant Health Benefits

For years, healthcare professionals have emphasized that losing 5 to 10 percent of your body weight can yield noticeable health improvements. This advice aimed to manage expectations, as it’s difficult to lose more through lifestyle changes alone, and this modest weight reduction already offers benefits like improved blood sugar, cholesterol, and blood pressure levels.

However, losing 15 to 20 percent of your body weight, which is more likely when combining lifestyle changes with second-generation GLP-1 drugs, can do more than just improve your health—it can lead to remission of several serious conditions, including:

• High blood pressure
• Diabetes
• Fatty liver disease
• Sleep apnea

This means that taking a GLP-1 medication might eventually allow you to stop using multiple other medications, according to Dr. Nadolsky.

Moreover, GLP-1 drugs appear to have health benefits beyond just weight loss. For example, they may reduce the risk of major cardiovascular events, such as heart attacks and strokes, in people with diabetes or heart disease. Research also suggests they improve kidney function in people with diabetes. The theory is that GLP-1 receptors on cells throughout the body, particularly in the kidneys and heart, may help protect these organs from damage.

In fact, the American Heart Association listed GLP-1 receptor agonists as one of 2023’s top advancements in cardiovascular care.

What Does a “Healthy Body Weight” Really Mean?

Many people strive to reach a “healthy weight,” but what exactly does that look like?

At Precision Nutrition, we believe your healthiest body composition or weight is one that:

• Includes more lean mass (muscle and dense bones) and less body fat.
• Results from sustainable health-promoting habits, not extreme measures like crash diets.
• Is easy to maintain with consistent lifestyle choices that don’t require excessive sacrifices.
• Allows you to perform and enjoy activities with minimal limitations.
• Keeps important health markers (blood pressure, cholesterol, blood sugar) in safe ranges.
• Feels good for you.

This definition isn’t tied to a specific size, body fat percentage, or place on a BMI chart. A healthy weight varies from person to person, which can feel both liberating and frustrating. Without a set number to aim for, it’s harder to know when you’ve reached your healthiest weight. However, focusing on behaviors you can control and how your life feels can be more empowering than obsessing over a number on the scale.

7 Strategies to Make Weight Loss Medications More Effective

Here’s the bottom line: Weight loss medications don’t replace lifestyle changes—they make them even more important.

When GLP-1 drugs reduce hunger and food cravings, many find it easier to focus on lean proteins, fruits, veggies, whole grains, and minimally processed foods. As the scale drops, people often feel better and more inclined to exercise, including activities like weightlifting.

In fact, according to a 2024 consumer trends survey, 41 percent of GLP-1 medication users reported exercising more after starting the medication. Many also reported an improvement in diet quality, opting for more protein, fruits, and vegetables. This supports the idea that medication isn’t a shortcut—it’s a tool to help facilitate healthier habits.

That said, some people may misuse the medication as a way to continue unhealthy eating patterns but in smaller quantities, which can lead to muscle and bone loss instead of fat loss. However, when used properly, weight loss medications can make healthy lifestyle changes easier to implement, ensuring that both the medication and the lifestyle changes work together for better short- and long-term success.

If you choose to take weight loss medications, here are seven strategies to help you maximize their effectiveness and protect your long-term health.

Strategy #1: Find Nutritious Foods You Can Eat Despite Side Effects

GLP-1 medications can slow down stomach emptying, which may cause nausea and constipation. Fortunately, most people find that these symptoms ease after a few weeks. However, if you’re feeling nauseous, the thought of eating a salad might be unappealing—similar to how you’d feel when you have the stomach flu.

Instead, try easier-to-digest options, like fruits and vegetables blended into smoothies or pureed soups. Dr. Nadolsky also advises avoiding common triggers such as:

• Large meal portions
• Greasy or fatty foods
• Highly processed foods
• Foods with strong smells
• Sugar alcohols (like xylitol, erythritol, and sorbitol), which can cause digestive issues like diarrhea

Strategy #2: Make Strength Training a Priority

When using GLP-1 medications, 30 to 40 percent of the weight lost can come from lean mass, including muscle and bone. For every 10 pounds lost, about 6-7 pounds are from fat, and 3-4 pounds from muscle and other tissues.

However, there are two important considerations:

1. People with severe obesity often have more muscle and bone mass to begin with, as their bodies have adapted to carrying extra weight.
2. Muscle loss isn’t unavoidable. In fact, Dr. Nadolsky emphasizes that muscle loss is a reason to increase physical activity, not avoid weight loss medication.

To preserve muscle and bone, aim for at least two full-body strength training sessions each week. Additionally, stay as active as possible. Walking and other forms of movement can keep your metabolism healthy and help food move through your digestive system.

Strategy #3: Boost Protein Intake

Strength training works best when paired with adequate protein intake to help preserve muscle mass. You can use a macros calculator to determine your ideal protein target. A general guideline is 1 to 2 palm-sized portions of protein per meal, or about 0.5 to 1 gram of protein per pound of body weight per day.

Strategy #4: Fill Your Plate with Fruits and Vegetables

Whole, fresh, and frozen produce not only provide essential nutrients but also help reduce inflammation. Chronic inflammation can hinder muscle maintenance by disrupting protein synthesis. Filling your diet with fruits and veggies can support overall health and muscle preservation.

Strategy #5: Opt for High-Fiber Carbohydrates

Carbs that are rich in fiber, like beans, lentils, whole grains, and starchy vegetables (potatoes and sweet potatoes), help you feel fuller longer and manage blood sugar better than processed, low-fiber carbs.

Strategy #6: Choose Healthy Fats

Healthy fats can improve satiety between meals and support overall health. Focus on fats from whole foods like avocados, seeds, nuts, and olive oil. Fatty fish is a great option too, as it provides both protein and healthy fats. Replace less healthy fats found in processed foods like chips and pastries with these healthier options.

Strategy #7: Consider Working with a Coach

The tips above are just a starting point. Other factors like quality sleep, stress management, and social support are also crucial for long-term success. While many people manage these changes independently, others find that working with a coach makes the process easier and more enjoyable.

A coach can help you overcome obstacles, build sustainable habits, and establish routines that make healthy living second nature. If you eventually decide to stop taking medication, the habits reinforced by coaching (and possibly made easier by the medication) will increase your chances of maintaining your results.